DAP-kinase and HOXA9, two human genes associated with genesis, progression, and aggressiveness of non-small cell lung cancer

ABSTRACT

The invention relates to the discovery of two markers that are informative for one or more of tumorigenesis, tumor progression, and tumor aggressiveness associated with non-small cell lung cancer (NSCLC). The markers are the HOXA9 gene and the gene encoding death-associated protein kinase (DAP-kinase) of humans. Methods of diagnosing NSCLC and methods of assessing the degree of progression and aggressiveness of NSCLC tumors are disclosed, as are methods of inhibiting or alleviating NSCLC. The invention also includes screening methods for identifying compounds that are useful for alleviating, inhibiting, or preventing NSCLC.

CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application is entitled to priority, pursuant to 35 U.S.C. §119(e), to U.S. Provisional Application No. 60/250,083 filed on Nov. 29, 2000.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

[0002] This research was supported in part by U.S. Government funds (National Cancer Institute grant number U19 CA68437), and the U.S. Government may therefore have certain rights in the invention.

REFERENCE TO A MICROFICHE APPENDIX

[0003] Not applicable.

BACKGROUND OF THE INVENTION

[0004] Worldwide, lung cancer is by far the most common cause of cancer and cancer related death in men (Parkin et al., 1999, CA Cancer J. Clin. 49:33-64). Lung cancer incidence has also increased significantly in women in recent years (Landis et al., 1998, CA Cancer J. Clin. 48:6-29). Despite improvements in the diagnosis and treatment of this disease in the past two decades, the survival rate remains dismal (Parkin et al., 1999, CA Cancer J. Clin. 49:33-64; Landis et al., 1998, CA Cancer J. Clin. 48:6-29).

[0005] Lung cancers can be classified into two major types, non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). NSCLC is much more common than SCLC, accounting for about 80% of all lung cancer cases. NSCLC can be divided histologically into two major histologic subtypes: squamous cell carcinoma and adenocarcinoma.

[0006] Development of NSCLC is a multi-step process involving accumulation of genetic and epigenetic alterations (Virmani et al., 1998, Genes Chromosomes Cancer 21:308-19; Minna, 1989, Chest 96(Suppl):17S-23S; Thiberville et al., 1995, Cancer Res. 55:5133-5139). Inactivation of tumor-suppressor genes is important in lung tumorigenesis and contributes to abnormal cellular proliferation, transformation, invasion, and metastasis associated with NSCLC (Greenblatt et al., 1994, Cancer Res. 54:4855-4878; Reissmann et al., 1993, Oncogene 8:1913-1919; Rosell et al., 1995, Ann. Oncol. 6 (Suppl 3):S15-S20; Kelley et al., 1995, J. Natl. Cancer Inst. 87:756-761).

[0007] For patients afflicted with early-stage NSCLC, standard treatment remains the complete surgical resection of primary tumors. Although this treatment is effective and can cure about 60% of the patients with stage I disease, the remaining 40% of patients will die of the disease within 5 years of surgery (Williams et al., 1981, J. Thorac. Cardiovasc. Surg. 82:70-76). With advances in the early detection of lung cancer (Henschke et al., 1999, Lancet 354:99-105), more patients with lung cancers can be diagnosed at earlier stages, permitting therapeutic or preventive intervention at a clinically relevant time.

[0008] The stage at which a lung cancer is detected is not the only determinant of the likelihood of successful treatment or inhibition of the cancer. Some cancers grow and spread (i.e., metastasize) more quickly than others, and are referred to as being more aggressive. Current diagnostic methods cannot accurately identify the aggressiveness of a lung cancer. Thus, the clinician sometime has little basis on which to judge how aggressively a detected tumor should be treated (e.g., whether the tumor should be treated by surgical resection alone, by chemotherapy, by radiation therapy, or by resection coupled with chemotherapy and/or radiation therapy in order to improve long-term survival).

[0009] A critical need exists for better diagnostic compositions and methods for classification of early-stage lung cancer. Improved diagnostic ability furthermore would permit analysis of the effectiveness of treatment and screening of potential therapeutic compositions. The present invention satisfies these needs, at least in part, by providing novel informative early stage NSCLC markers.

BRIEF SUMMARY OF THE INVENTION

[0010] The invention relates to a method of diagnosing non-small cell lung cancer (NSCLC) at an early stage in a human. The method comprises assessing expression of the gene encoding DAP-kinase in lung cells of the human (e.g., in cells obtained from the human). A lower degree of expression of the gene in the human, relative to a normal level of expression of the gene in humans not afflicted with NSCLC, is an indication that NSCLC tumorigenesis is occurring in the human. Expression of the gene can be assessed by assessing the methylation state of the gene (or the methylation state of the promoter CpG region of the gene).

[0011] The invention also relates to a method of assessing NSCLC tumorigenesis at an early stage in a human. This method comprises assessing methylation of the gene encoding DAP-kinase in lung cells of the human.

[0012] The invention includes a method of assessing aggressiveness of a NSCLC tumor in a human. The method comprises assessing methylation of the gene encoding DAP-kinase in lung cells of the human. A higher degree of methylation of the gene an indication that the tumor is more aggressive.

[0013] Methods disclosed herein can be used to select among methods of treating a NSCLC tumor in a human, for example by assessing methylation of the gene encoding DAP-kinase in lung cells of the human and selecting a more aggressive treatment when a higher degree of methylation of the gene is detected.

[0014] In another aspect, the invention includes a method of inhibiting NSCLC tumorigenesis in a human. This method comprises inhibiting methylation of the DAP-kinase gene in lung cells of the human. Methylation of the DAP-kinase gene in cells of a NSCLC tumor can also be used to inhibit progression of the tumor or to reduce the aggressiveness of the tumor. Alternatively, NSCLC tumorigenesis can be inhibited in a human by de-methylating the DAP-kinase gene in lung cells of the human. This method can also be used to inhibiting progression of a NSCLC tumor or to reduce the aggressiveness of the tumor.

[0015] The invention includes a prognostic method of assessing the risk that a human will develop NSCLC. This prognostic method comprises assessing expression of the gene encoding DAP-kinase in lung cells of the human. A lower degree of expression of the gene in the human, relative to a normal level of expression of the gene in humans not afflicted with NSCLC, is an indication that the human is at an increased risk for developing NSCLC.

[0016] In still another aspect, the invention includes a method of assessing whether a test compound is useful for one or more of inhibiting NSCLC tumorigenesis, progression of a NSCLC tumor, and aggressiveness of a NSCLC tumor. In this method, methylation of the DAP-kinase gene in the presence of the test compound and methylation of the gene in the absence of the test compound are compared, and a lower degree of gene methylation in the presence of the test compound is an indication that the test compound is useful for the selected purpose.

[0017] The invention further includes a method of preventing NSCLC in a human at risk for developing NSCLC by inhibiting methylation of the DAP-kinase gene in lung cells of the human or by enhancing de-methylation of that gene.

[0018] The invention includes a method of alleviating NSCLC in a human by inhibiting methylation of the DAP-kinase gene in lung cells of the human or by enhancing de-methylation of that gene.

[0019] In another aspect, the invention relates to a method of diagnosing NSCLC at an early stage in a human. This method comprises assessing expression of the HOXA9 gene in lung cells of the human. A greater degree of expression of the gene in the human, relative to a normal level of expression of the gene in humans not afflicted with NSCLC, is an indication that the human is afflicted with NSCLC. This method can also be used to assess the risk that a human will develop NSCLC, a greater degree of expression of the gene in the human, relative to a normal level of expression of the gene in humans not afflicted with NSCLC, being an indication that the human is at an increased risk for developing NSCLC.

[0020] NSCLC tumorigenesis can be inhibited in a human by inhibiting expression of the HOXA9 gene in lung cells of the human. Likewise, progression of a NSCLC tumor (i.e., from a lower to a higher diagnostic stage) can be inhibited by inhibiting expression of the HOXA9 gene in cells of the tumor.

[0021] The invention includes a screening method for assessing whether a test compound is useful for inhibiting one or both of NSCLC tumorigenesis and progression of a NSCLC tumor. This screening method comprises comparing expression of the HOXA9 gene in the presence of the test compound and expression of the gene in the absence of the test compound. A lower degree of expression in the presence of the test compound is an indication that the test compound is useful for the selected purpose.

[0022] The invention further relates to a method of preventing NSCLC in a human at risk for developing NSCLC, the method comprising inhibiting expression of the HOXA9 gene in lung cells of the human.

[0023] In another aspect, the invention includes a method of alleviating NSCLC in a human. This method comprising inhibiting expression of the HOXA9 gene in lung cells of the human.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS

[0024] The foregoing summary, as well as the following detailed description of preferred embodiments of the invention, will be better understood when read in conjunction with the appended drawings. For the purpose of illustrating the invention, there is shown in the drawings embodiments which are presently preferred. It should be understood, however, that the invention is not limited to the precise arrangements and instrumentalities shown.

[0025]FIG. 1, comprising FIGS. 1A-1D, is a quartet of graphs which depict the relationship between DAP-kinase hypermethylation in primary NSCLC and probability of survival. The Kaplan-Meier method was used to determine the survival probability and the log-rank test to compare the survival curve between groups. FIG. 1A is a graph depicting overall survival for patients who exhibited the DAP-kinase hypermethylation and patients who did not exhibit the alteration. FIG. 1B is a graph depicting disease-specific survival times for patients exhibited the DAP-kinase hypermethylation and patients who did not exhibit the alteration. FIG. 1C is a graph depicting disease-specific survival times for patients who were afflicted with adenocarcinoma and who exhibited the DAP-kinase hypermethylation and patients who were afflicted with adenocarcinoma and who did not exhibit hypermethylation. FIG. 1D is a graph depicting disease-specific survival times for patients who were afflicted with squamous cell carcinoma and who exhibited the DAP-kinase hypermethylation and patients who were afflicted squamous cell carcinoma and who did not exhibit hypermethylation.

[0026]FIG. 2, comprising FIGS. 2A-2F, is a series of images which illustrate the results of assays to detect expression of HOXA9 in cells obtained from patients afflicted with NSCLC. FIG. 2A is an image of results from an assay to detect expression of HOXA9 in primary NSCLC and corresponding normal lung tissues, as assessed by RT-PCR (M indicates DNA size markers; N, indicates normal lung tissues; T indicates primary NSCLC; and Neg, indicates negative control). FIGS. 2B-2E are images of results of in situ hybridization experiments to detect HOXA9 gene expression in primary NSCLC (FIG. 2B) and in normal-appearing bronchial epithelium obtained from the same patient (FIG. 2D). In FIGS. 2C and 2E, a sense riboprobe was used to hybridize the same specimens as negative controls. FIG. 2F is an image of the results of an assay to detect HOXA9 expression in bronchial brush specimens obtained from former smokers (P indicates positive control; N indicates negative control; and M indicates DNA size markers).

[0027]FIG. 3 is the nucleotide sequence of GENBANK® accession no. X76104.

[0028]FIG. 4 is the nucleotide sequence of GENBANK® accession no. NM_(—)002142.

DETAILED DESCRIPTION OF THE INVENTION

[0029] The invention relates to discovery of the involvement of two genes in non-small cell lung cancer (NSCLC), particularly including at the early stages of NSCLC. One of the genes, that encoding death-associated protein kinase (DAP-kinase), has been found to be susceptible to methylation at certain sites, particularly including CpG sites in the 5′-untranslated region of the gene. Methylation of this region inhibits expression of the gene and enhances NSCLC tumorigenesis, tumor progression, and tumor aggressiveness. The other of these two genes, designated HOXA9, is one of the homeobox family of genes, and is expressed beginning at an early stage in the onset of NSCLC. Expression of HOXA9 enhances NSCLC tumorigenesis and tumor progression. The invention includes diagnostic, prognostic, therapeutic, and preventive methods for NSCLC and compositions and kits for use in such methods.

[0030] The Gene Encoding DAP-Kinase

[0031] In one embodiment, the invention includes a method of diagnosing NSCLC at an early stage in a human. This method comprises assessing expression of the gene encoding DAP-kinase in lung cells of the human. A lower degree of expression of the gene in the human, relative to a normal level of expression of the gene in humans not afflicted with NSCLC, is an indication that NSCLC tumorigenesis is occurring in the human. Expression of this gene is inhibited by methylation in its 5′-untranslated region, presumably by inhibiting translation of the gene.

[0032] Expression of the gene encoding DAP-kinase (e.g., that corresponding to GENBANK™ accession no. X76104; reproduced in FIG. 3; SEQ ID NO: 4) can be assessed using a variety of known methods. For example, expression of the gene can be assessed in vitro in cells obtained (e.g., by bronchial lavage or biopsy) from a human. Expression of the gene can be assessed directly (e.g., by detecting the primary transcript, the mRNA, or the protein corresponding to the gene) or indirectly, such as by assessing the methylation state of the gene.

[0033] A preferred method of assessing the methylation state of the gene comprises assessing the ability of an oligonucleotide to hybridize with the gene in the genome. Alternatively, a pair of oligonucleotide primers able to hybridize with complementary strands of the gene are used, so that a portion of the gene between the two primers can be amplified using known polymerase chain reaction (PCR) procedures. In addition, oligonucleotides or primers which specifically hybridize with a portion of the gene that is susceptible to methylation can be used. In one embodiment, individual oligonucleotides, or oligonucleotide primer pairs, are designed so that the oligonucleotide(s) hybridize with either the methylated or non-methylated form of the complementary region of the gene, but not with both. Using these oligonucleotides, methylated forms of the gene can be differentiated from non-methylated forms, and the methylation state of the gene can be assessed.

[0034] Assessment of the methylation state of the gene encoding DAP-kinase in a human (e.g., one who does not exhibit a macroscopic clinical symptom of NSCLC or one afflicted with a diagnostic stage I NSCLC tumor) is informative with respect to i) whether the human is at risk of developing NSCLC; ii) whether the human is afflicted with NSCLC; iii) the degree of progression and likelihood of further progression of NSCLC in the human, and iv) the aggressiveness of an NSCLC tumor in the human. “Aggressiveness” of a tumor refers individually and collectively to the proliferative, invasive, and metastatic prognosis for the tumor. Identification of a tumor as aggressive can indicate that more aggressive therapeutic methods should be employed to treat or inhibit the tumor than might otherwise be employed owing, for example, to side effects and dangers associated with the more aggressive therapy.

[0035] Common macroscopic signs and symptoms of NSCLC include a cough that does not go away and gets worse over time, constant chest pain, coughing up blood, shortness of breath, wheezing, or hoarseness, repeated problems with pneumonia or bronchitis, swelling of the neck and face, loss of appetite or weight loss, and fatigue. NSCLC includes various types of lung cancers, including squamous cell carcinoma (i.e., epidermoid carcinoma), adenocarcinoma, large cell carcinoma, adenosquamous carcinoma, and undifferentiated carcinoma.

[0036] The methylation state of the gene encoding DAP-kinase can be used in risk assessment methods. In these methods, the methylation state of the gene is assessed in lung cells obtained from a human. A lower degree of expression of the gene in the human, relative to a normal level of expression of the gene in humans not afflicted with NSCLC, is an indication that the human is at an increased risk for developing NSCLC.

[0037] Without being bound by any particular theory of operation, it is believed that methylation of the gene encoding DAP-kinase is not only a symptom of NSCLC, but also a contributing factor in NSCLC tumorigenesis, tumor progression, and tumor aggressiveness. Therefore, prevention or inhibition of DAP-kinase gene methylation can inhibit, delay, or prevent one or more of genesis, progression, and aggressiveness of NSCLC tumors. Furthermore, reversal of gene methylation (i.e., enhancement of gene de-methylation) can inhibit or even reverse genesis, progression, and aggressiveness of NSCLC tumors.

[0038] Involvement of the gene encoding DAP-kinase in these activities indicates that screening methods that assess the ability of a test compound to inhibit or reverse methylation of the gene can be used to identify compounds useful in treatment, alleviation, or prevention of NSCLC. The invention includes a method of assessing whether a test compound is useful for inhibiting one of i) NSCLC tumorigenesis, ii) progression of a NSCLC tumor, and iii) aggressiveness of a NSCLC tumor. This method comprises comparing methylation of the DAP-kinase gene in the presence of the test compound and methylation of the gene in the absence of the test compound. A lower degree of gene methylation in the presence of the test compound is an indication that the test compound is useful for one or more of these purposes. Once a compound having one of these activities has been identified, it can be incorporated into a pharmaceutical composition suitable for ethical administration to humans and used to alleviate, inhibit, or prevent NSCLC.

[0039] The HOXA9 Gene

[0040] The invention includes another method of diagnosing NSCLC at an early stage in a human. This method comprising assessing expression of the HOXA9 gene in lung cells of the human. A greater degree of expression of the gene in the human, relative to a normal level of expression of the gene in humans not afflicted with NSCLC, is an indication that the human is afflicted with NSCLC. In fact, expression of the HOXA9 gene in humans not afflicted with NSCLC can be very low or even undetectable. Thus, detection of expression of the HOXA9 gene at all in lung cells (particularly in lung epithelial cells such as those obtained in bronchial lavage, sputum, or biopsy samples) can be indicative of NSCLC in a human. Thus, this method can be used to diagnose NSCLC even in a human who does not exhibit any macroscopic clinical symptom of NSCLC.

[0041] In one embodiment, expression of the HOXA9 gene is assessed using an oligonucleotide that specifically hybridizes with a transcription product of the gene, such as an oligonucleotide described in this disclosure. Because the HOXA9 gene is normally present in the genome of cells, the oligonucleotide preferably does not specifically hybridize with the gene. For example, an oligonucleotide which hybridizes with HOXA9 mRNA (e.g., the mRNA described in GENBANK™ accession no. NM_(—)002142; reproduced in FIG. 4; SEQ ID NO: 6), but not with the HOXA9 gene or its primary transcript can be designed (e.g., by using a sequence which bridges the 3′- and 5′-ends of adjacent exons of the gene). In another embodiment, expression of the gene is assessed using a pair of oligonucleotide primers in a PCR method to amplify a portion of the gene or its corresponding mRNA. For example, the portion can include sub-portions wherein an intron is interposed between the sub-portions in the gene, but wherein the sub-portions are adjacent in mRNA derived from the gene.

[0042] Assessment of HOXA9 gene expression can be used to assess the risk that a human will develop NSCLC. In this method, expression of the gene is assessed in lung cells of the human. A greater degree of expression of the gene in the human, relative to a normal level of expression of the gene in humans not afflicted with NSCLC, is an indication that the human is at an increased risk for developing NSCLC.

[0043] Without being bound by any particular theory of operation, it is believed that HOXA9 gene expression is not only a symptom of NSCLC, but also a cause of NSCLC tumorigenesis, an enhancer of NSCLC tumor progression, or both. Thus, genesis and progression of NSCLC can be inhibited or prevented by inhibiting or preventing expression of the HOXA9 gene in human lung cells. This can be achieved, for example, by administration of an antisense oligonucleotide (or another composition) designed to inhibit HOXA9 gene transcription, or translation of the mRNA derived therefrom, to human pulmonary epithelial cells.

[0044] Involvement of the HOXA9 gene in NSCLC and its onset and progression means that expression of HOXA9 can be used as a marker for assessing the effectiveness of a test compound for alleviating, inhibiting, or preventing NSCLC. The invention includes a method of assessing whether a test compound is useful for inhibiting one of i) NSCLC tumorigenesis and ii) progression of a NSCLC tumor. The method comprises comparing expression of the HOXA9 gene in the presence of the test compound and expression of the gene in the absence of the test compound. A lower degree of expression in the presence of the test compound is an indication that the test compound is useful.

[0045] The invention is now described with reference to the following Examples. These Examples are provided for the purpose of illustration only and the invention is not limited to these Examples, but rather encompass all variations which are evident as a result of the teaching provided herein.

EXAMPLES Example 1

[0046] Hypermethylation of the DAP-Kinase Promoter Predicts Aggressiveness in Stage I Non-Small Cell Lung Cancer

[0047] Death-associated protein kinase (DAP-kinase; also known as DAP-2) is a serine/threonine kinase required for interferon-gamma-induced apoptosis (Feinstein et al., 1995, Genomics 29:305-307). In murine models, lung carcinoma clones which exhibit highly aggressive metastatic behavior lack DAP-kinase expression, and clones which exhibit low metastatic capability express the protein (Inbal et al., 1997, Nature 390:180-184). Restoration of DAP-kinase to physiological levels in highly metastatic carcinoma cells can suppress the metastatic ability of these cells (Inbal et al., 1997, Nature 390:180-184). Thus, association of DAP-kinase expression with metastatic tendency is known, and it can be concluded that DAP-kinase functions, directly or indirectly, as a metastatic suppressor.

[0048] Expression of DAP-kinase is repressed in several types of human cancers on account of hypermethylation in the promoter CpG region of the gene (Katzenellenbogen et al., 1999, Blood 93:4347-4353; Kissil et al., 1997, Oncogene 15:403-407; Esteller et al., 1999, Cancer Res. 59:67-70). However, it was not previously known whether decreased expression (or non-expression) of DAP-kinase is associated with early stage NSCLC, or whether decreased expression of this enzyme occurs later in progression of NSCLC. The Experiments presented in this Example were performed in order to determine whether DAP-kinase gene is frequently inactivated by hypermethylation during an early stage of lung tumorigenesis. These experiments also determined whether inactivation of DAP-kinase expression is informative with regard to the aggressiveness of a lung tumor.

[0049] In the experiments presented in this Example, surgically resected primary lung tumor tissue samples obtained from 135 patients afflicted with pathologic stage I NSCLC were analyzed in order to determine the methylation status of CpG sites located in the 5′ end of the DAP-kinase gene. Statistical analysis identified the prognostic effect of DAP-kinase gene hypermethylation state on detection of early stage NSCLC and the aggressiveness of the tumor in the patient.

[0050] The materials and methods used in the experiments presented in this Example are now described.

[0051] Study Population

[0052] One hundred and thirty-five patients who had been diagnosed with pathologic stage I NSCLC and had undergone lobectomy or pneumonectomy for complete resection of their primary tumors were enrolled in the study. Patients were followed-up for at least 5 years. The follow-up information was based on chart review and reports from a tumor registry service. None of the patients received adjuvant chemotherapy or radiation therapy before or after surgery. Tissue sections (4 micrometers thick) were obtained from each tissue sample, stained with hematoxylin-eosin, and reviewed by two pathologists to confirm the diagnosis and the presence of tumor cells in the sections.

[0053] Microdissection and DNA Extraction

[0054] Sections (8 micrometers thick) were obtained from formalin-fixed and paraffin-embedded tissue blocks. Tumorous parts of each section were dissected under a stereomicroscope as described previously (Kim et al., 1997, Cancer Res. 57:400-403; Mao et al., 1996, Nature Med. 2:682-685). Dissected tissues were digested in 200 microliters of digestion buffer containing 50 millimolar Tris-HCl (pH 8.0), 1% (w/v) sodium dodecyl sulfate, and 0.5 milligrams per milliliter proteinase K at 42° C. for 36 hours. The digested products were purified by treating them twice with phenylchloroform. DNA was precipitated using the ethanol precipitation method in the presence of glycogen (obtained from Boehringer-Mannheim, Indianapolis, Ind.) and recovered in distilled water.

[0055] Methylation-Specific PCR

[0056] Two hundred nanograms of DNA obtained from each tumor sample was used in the initial step of chemical modification. Briefly, DNA was denatured using NaOH and treated with sodium bisulfite (obtained from Sigma, St. Louis, Mo.). After purification using WIZARD™ DNA purification resin (Promega, Madison, Wis.), the DNA was treated again with NaOH. After precipitation, DNA was recovered in water and ready for PCR. PCR was performed using primers which specifically amplified either the methylated DAP-kinase promoter or the non-methylated one, as described (Esteller et al., 1999, Cancer Res. 59:67-70). The primers were the same as those used by Esteller et al.

[0057] PCR reactions were performed in a 25-microliter volume containing about 10 nanograms of modified DNA, 3% (v/v) dimethylsulfoxide, 200 micromolar dNTPs, 1.5 millimolar magnesium chloride, 0.4 micromolar PCR primers, and 1.25 units of Taq DNA polymerase (obtained from GIBCO BRL, Gaithersburg, Md.). Amplification was performed for 35 cycles at 95° C. for 30 seconds, 60° C. for 60 seconds, and 70° C. for 60 seconds per cycle, followed by a 5-minute extension at 70° C. in a temperature cycler (HYBAID™, Omnigene, Woodbridge, N.J.) in 500-microliter plastic tubes.

[0058] PCR products were separated on 2% (w/v) agarose gels and visualized after staining with ethidium bromide. For each DNA sample, primer pairs specific for methylated DNA and non-methylated DNA were analyzed. Hypermethylation status was determined by visualizing a 98-base pair PCR product using the methylation-specific primer set. All PCR reactions were repeated twice, and the results were reproducible.

[0059] Statistical Analysis

[0060] Survival probability was computed as a function of time using the Kaplan-Meier estimator. The variance of the Kaplan-Meier estimator was computed by the Greenwood formula. The 5-year survival rates were estimated and compared by the asymptotic Z-test between the hypermethylated and non-hypermethylated groups. The log-rank test was used to compare patient survival times between groups. Both overall survival and disease-specific survival (i.e., death due to lung cancer-related causes) were analyzed. The two-sided chi-squared test was used to test equal proportion between groups in two-way contingency tables. Cox regression was used to model the risks of DAP-kinase hypermethylation on survival time, with adjustment for clinical and histopathological parameters.

[0061] The results of the experiments presented in this Example are now described.

[0062] A total of 135 patients were evaluated in this study. All patients underwent only surgical treatment for their primary tumors. Ninety-one patients died, and 44 patients were still alive at the time of the last follow-up report. Among the 91 deceased patients, 39 died as a result of lung cancer, 16 as a result of heart diseases, 16 as a result of respiratory diseases, 3 as a result of other organ failures, and 17 for unknown reasons. The median follow-up time was 8.5 years among the surviving patients. Patient ranged in age from 41 to 82 years, with a median age of 62.8 years. Thirty-five (26%) of the patients were women and 100 (74%) were men, which is comparable to the gender distribution of the disease in 1970s and 1980s (Landis et al., 1998, CA Cancer J. Clin. 48:6-29). The probability of 5-year overall survival was 59% and of 5-year disease-specific survival, was 76% in this patient population, similar to probabilities reported in a previous study with a large number of similar patients (Mountain, 1989, Chest 96:47S-49S). The general clinical characteristics of the patients are shown in Table 1.

[0063] We analyzed the hypermethylation status of CpG sites located in the 5′-non-translated region of the gene encoding DAP-kinase in primary tumor samples obtained from the 135 patients diagnosed with pathologic stage I NSCLC. Because tumor sections were dissected under a stereomicroscope, tumor cell populations comprised 70 percent or more of most of the specimens. The primer sets for both hypermethylated sequences and non-hypermethylated sequences were tested using non-modified genomic DNA, modified DNA obtained from normal tissues, and modified DNA which exhibited hypermethylation of the CpG sites. DNA was modified as described in Tang et al. (2000, J. Natl. Cancer Inst. 92(18):1460-1461). Non-modified genomic DNA could not be amplified using either the hypermethylated primer set or the non-hypermethylated one. Modified normal and hypermethylated DNA could be effectively amplified using only the corresponding primer sets. Modified DNA from 59 (44 percent) of the 135 tumors could be amplified using the methylation specific primer set and exhibited a specific 98 base pair PCR product, indicating the presence of tumor cells having hypermethylated CpG sites at the critical region of the DAP-kinase gene in these tumors (as indicated in Table 2). Selected PCR amplification products obtained using methylated and non-methylated primer sets were directly sequenced, and the methylation status was verified.

[0064] The methylation state of the DAP-kinase gene determined in the tumor samples was analyzed in view of patients' gender and age. No statistical association could be detected between these factors, although there was a trend toward more frequent methylation in men (P=0.09). Hypermethylation was observed more frequently in adenocarcinoma and other histologic types (large cell and unclassified tumors) than it was in squamous cell carcinoma (P=0.02, as indicated in Table 2).

[0065] The data were also analyzed for potential associations between the hypermethylation status of the DAP-kinase gene in the primary tumors and patient survival data. Patients whose primary tumors exhibited hypermethylation had a significantly poorer overall survival rate (P=0.041, as assessed using the log-rank test). The probability of survival 5 years after surgery was 68±5% for patients whose tumors did not exhibit hypermethylation, but only 46±7% for patients whose tumor samples exhibited DAP-kinase gene hypermethylation (as indicated in FIG. 1A). Five-year survival rates were significantly different between the non-hypermethylated and hypermethylated groups (P=0.007, as assessed using the Z-test). Survival probability 10 years after surgery was also lower for patients who exhibited a hypermethylated DAP-kinase gene in their tumor DNA.

[0066] Strikingly, for the group of patients whose primary tumors did not exhibit hypermethylation at the CpG sites of the DAP-kinase gene, the probability of 5-year disease-specific survival was 92±3%, but only 56±7% for patients in whose tumors DAP-kinase gene hypermethylation occurred (as indicated in FIG. 1B). The probability of 10-year disease-specific survival was similarly strikingly different (83±5% in patients who did not exhibit hypermethylation and 37±8% in those who did). Disease-specific survival rate was highly significantly different between the two groups (P<0.0001, as assessed using the log-rank test and the Z-test). Unlike overall survival, differences in disease-specific survival increased with follow-up time. Similar trends were observed if the 17 patients who died for unknown reasons were included in the disease-specific mortality group.

[0067] The data were also assessed in order to detect potential associations between the hypermethylation pattern and disease-specific survival rate in histologic subgroups. Hypermethylation was associated with a poorer disease-specific survival in both adenocarcinoma (P=0.0002) and squamous cell carcinoma (P=0.011), as indicated in FIGS. 1C and 1D.

[0068] Multivariate analysis was performed, using the Cox model, in order to determine whether hypermethylation of the CpG sites of the DAP-kinase gene is an independent factor in predicting survival time for patients with pathologic stage I NSCLC. Hypermethylation of the CpG sites in the DAP-kinase gene was found to be the only independent predictor for disease-specific survival rates (P<0.0001) among available parameters, including age, gender, histology, tumor size, and tobacco-smoking/non-smoking status. DAP-kinase hypermethylation was a significant independent factor predicting the overall survival during the first 5 years of follow-up (P=0.008 and P=0.14, respectively).

[0069] Many physiological factors such as tumor necrosis factor-alpha, interferon-gamma, and transforming growth factor-beta (TGF-beta) can trigger apoptosis in normal cells (Laster et al., 1988, J. Immunol. 141:2629-2634; Novelli et al., 1994, J. Immunol. 152:496-504; Lin et al., 1992, Cancer Res. 52:385-388). However, tumor cells can lose their ability to respond to these stimulating factors. For example, many lung cancer cell lines do not respond to TGF-beta (Schwarz et al., 1990, Growth Factors 3:115-127), indicating the presence of defects in the TGF-beta-induced signaling pathway.

[0070] DAP-kinase was initially identified as a gene whose down-regulation by an anti-sense molecule could prevent HeLa cells from undergoing interferon-gamma-induced apoptosis (Feinstein et al., 1995, Genomics 29:305-307). Others have shown that DAP-kinase is a Ca²⁺/calmodulin-dependent, cytoskeleton-associated protein kinase, and that its apoptosis-inducing function depends on its catalytic activity (Cohen et al., 1997, EMBO J. 16:998-1008). It has been suggested that the ability of DAP-kinase to suppress the metastatic behavior of Lewis lung carcinoma cells in animal models indicates that the protein might function as a metastasis suppressor by inducing apoptosis (Inbal et al., 1997, Nature 390:180-184).

[0071] Others studied primary NSCLC samples obtained from 22 patients and observed that DAP-kinase was hypermethylated in 5 (23%) of the patients' tumors (Esteller et al., 1999, Cancer Res. 59:67-70). Although these observations indicate that DAP-kinase hypermethylation is a frequent abnormality in lung cancer patients, those observations do not indicate whether such hypermethylation was an informative indicator of tumorigenesis, tumor progression, or tumor aggressiveness. It was not until the statistically significant studies described in this Example were completed that these associations could be made.

[0072] In the studies described in this Example, a panel of 135 tumor samples was assessed in a single clinical stage, which permitted determination of the rate of DAP-kinase hypermethylation across a relatively small subset of patients with lung cancer. 44% of the tumor samples exhibited hypermethylation at the CpG sites of the DAP-kinase gene. Previous studies demonstrated that hypermethylation at the CpG sites of the DAP-kinase can repress expression of the gene (Katzenellenbogen et al., 1999, Blood 93:4347-4353; Kissil et al., 1997, Oncogene 15:403-407). Therefore, using the results described in this Example, it was possible, for the first time, to associate DAP-kinase gene methylation status with tumorigenesis, tumor progression, and tumor aggressiveness.

[0073] The results presented in this Example establish that DAP-kinase gene expression can affect one or more of tumorigenesis, tumor progression, and tumor aggressiveness. These results also indicate that tumorigenesis, tumor progression, and tumor aggressiveness can be inhibited by de-methylating a hypermethylated DAP-kinase gene or by inhibiting methylation of this gene.

[0074] The most striking finding of the experiments presented in this Example is the strong association observed between DAP-kinase hypermethylation and adverse survival, particularly disease-specific survival. Multivariate analysis indicates that DAP-kinase hypermethylation was the only independent factor for predicting disease-specific survival rates. Several other molecular and genetic markers have been shown to be able to predict outcome of patients with stage I NSCLC, such as loss of heterozygosity, K-ras mutations, and p53 overexpression (Miyake et al., 1999, Oncogene 18:2397-2404; Graziano et al., 1999, J. Clin. Oncol. 17:668-675; Kwiatkowski et al., 1999, J. Clin. Oncol. 16:2468-2477; Rosell et al., 1993, Oncogene 8:2407-2412; Zhou et al., 2000, Clin. Cancer Res. 6:559-565; Herbst et al., 2000, Clin. Cancer Res. 6:790-797). However, contradictory results have also been reported for some markers (Apolinario et al., 1997, J. Clin. Oncol. 15:2456-2466; Pastorino et al., 1997, J. Clin. Oncol. 15:2858-2865), suggesting that the roles of those markers in lung cancer progression are complicated. The results presented in this Example demonstrate for the first time that inactivation of DAP-kinase is an important biomarker for the molecular classification of stage I NSCLC. These findings add one more step towards the development of a model for molecular classification of lung cancer.

[0075] The advantages of methylation-specific PCR include the simplicity of the technique, its specificity for the gene, and its high sensitivity. These advantages permit investigators to detect a single altered gene in an environment containing more than 1,000 normal copies of the gene (Herman et al., 1996, Proc. Natl. Acad. Sci. USA 93:9821-9826). In contrast to many other methods of genetic testing, this assay is easy to perform and cost-effective. Furthermore, data interpretation is straightforward, making it possible to compare results across investigators and institutions. It may be that only a small percentage of cells in a particular tumor are capable of metastasis. Therefore, the high sensitivity of methylation-specific PCR will help to identify these abnormal cells among large numbers of cells which do not exhibit this abnormality.

[0076] The association between DAP-kinase hypermethylation and poor survival rates indicates that DAP-kinase has an important role in tumor invasion and metastasis of lung cancer. Tumor cells which lack DAP-kinase or which express reduced levels of DAP-kinase demonstrate more aggressive behavior in terms of invasion and metastasis in NSCLC.

[0077] Recent data generated by others indicates that the death domain of DAP-kinase is critical in ligand-induced apoptosis (Cohen et al., 1999, J. Cell Biol. 146:141-148). DAP-kinase is also involved in apoptosis induced by tumor necrosis factor-alpha and by Fas. Furthermore, DAP-kinase apoptotic function can be blocked by bcl-2 as well as by p35 inhibitors of caspases (Cohen et al., 1999, J. Cell Biol. 146:141-148). Those observations, in combination with the results presented in this Example, indicate that DAP-kinase is a useful therapeutic target for treatment of NSCLC patients, including those who may harbor a high probability of recurrence and metastasis. TABLE 1 Demographic characteristics of the patient population Squamous cell Histology carcinoma Adenocarcinoma Others Total # of Patients 51 (38%) 71 (53%) 13 (10%)  135 (100%) Gender Male 41 (80%) 48 (68%) 11 (85%) 100 (74%) Female 10 (20%) 23 (32%)  2 (15%)  35 (26%) Mean age (±S.D.) 64.6 ± 9.1 61.3 ± 8.9 63.6 ± 8.2 62.8 ± 9.0 Smoking status Smoker 43 (81%) 61 (84%) 11 (85%) 115 (85%) Nonsmoker  8 (19%) 10 (16%)  2 (15%)  20 (15%) 5-year survival rate in % (± standard error) Overall 59 ± 7 63 ± 6  31 ± 13 58 ± 4 Disease-specific 84 ± 6 77 ± 5  47 ± 15 76 ± 4

[0078] TABLE 2 Hypermethylation of DAP-kinase gene in stage I NSCLC Hypermethylation Yes (%) No (%) Total (100%) Number of patients 59 (44%) 76 (56%) 135 Gender^(#) Male 48 (48%) 52 (52%) 100 Female 11 (31%) 24 (69%) 35 Age <60 21 (40%) 32 (60%) 53 ≧60 38 (46%) 44 (54%) 82 Histology* Squamous 16 (31%) 35 (69%) 51 Adeno 34 (48%) 37 (52%) 71 Others  9 (69%)  4 (31%) 13

Example 2

[0079] The HOXA9 Gene is Widely Activated in Bronchial Epithelium of Patients Afflicted With Lung Cancer

[0080] Homeobox (HOX) genes have an important role in pattern formation during development and in maintaining the differentiated state of cells in an adult organism (Krumlauf, 1994, Cell 78:191-201; Vincent et al., 1994, Cell 77:909-915). Deregulation of HOX genes has an important role in tumorigenesis. For example, t(10;14)(q24;q11) translocation was detected in a subset of T-cell leukemia cells and activated HOX11 (Hatano et al., 1991, Science 253:79-82). Similarly, HOXA9 is transcriptionally activated in a subset of acute myeloid leukemias when the t(7;11)(p15;p15) translocation occurs (Nakamura et al., 1996, Nature Genet. 12:154-158). Activation of the HOXB3, HOXB4, and HOXC6 genes in lung carcinomas has also been reported (Bodey et al., 2000, Anticancer Res. 20:2711-2716).

[0081] A survey was performed in order to detect deregulation of HOX genes in lung cancer-associated cells. A panel of NSCLC cell lines was examined, and it was determined that the HOXA9 gene was expressed in all cell lines analyzed, as assessed using reverse transcription polymerase chain reaction (RT-PCR). HOXA9 gene expression could not detected in this way in a cDNA library generated from the lung tissue of a 17-year-old female non-smoker or in cDNA generated from a normal bronchial epithelial cell line transformed with the SV-40 large antigen.

[0082] Surgically resected primary NSCLC tumors obtained from 30 patients were assessed, and it was determined that 27 (90%) of the 30 tumors expressed HOXA9 messenger RNA (mRNA; as illustrated in FIG. 2A). PCR primers used in the HOXA9 detection methods were designed to flank a 1-kb intron to amplify a 218-bp cDNA fragment. The sequences of these primers were CCGGCCTTAT GGCATTAAAC (SEQ ID NO: 1) and AGTTGGCTGC TGGGTTATTG (SEQ ID NO: 2). Thus, PCR amplification products generated from contaminating genomic DNA could be easily distinguished from those generated from cDNA, owing to the size differences attributable to the presence (i.e., in genomic DNA) or absence (i.e., in the cDNA) of the intron. The RT-PCR amplification product having the expected size was directly sequenced, and matched the published HOXA9 mRNA sequence. Surprisingly, HOXA9 was expressed not only in NSCLC cells, but also in corresponding normal lung tissues located distant to the primary NSCLC in all 30 tumors, suggesting that HOXA9 is activated and has an important role in the early development of NSCLC.

[0083] In order to assess local HOXA9 expression at the cellular level, mRNA in situ hybridization was performed using an antisense ribonucleotide probe that specifically hybridized with HOXA9 mRNA. The nucleotide sequence of this probe was CCGGCCTTAT GGCATTAAAC CTGAACCGCT GTCGGCCAGA AGGGGTGACT GTCCCACGCT TGACACTCAC ACTTTGTCCC TGACTGACTA TGCTTGTGGT TCTCCTCCAG TTGATAGAGA AAAACAACCC AGCGAAGGCG CCTTCTCCGA AAACAATGCC GAGAATGAGA GCGGCGGAGA CAAGCCCCCC ATCGATCCCA ATAACCCAGC AGCCAACT (SEQ ID NO: 3). Expression of HOXA9 was found to be restricted to lung carcinoma cells and bronchial epithelial cells in the corresponding normal lung tissues in all 5 pairs of tumor/normal tissue pairs analyzed, as illustrated in FIGS. 2B-2E).

[0084] In order to determine whether expression of the HOXA9 gene in normal bronchial epithelium precedes development of invasive lung cancer (i.e., rather than merely being symptomatic of NSCLC) bronchial brush tissue specimens obtained from former smokers were analyzed for HOXA9 expression. Although none of these individuals exhibited symptoms of lung cancer, they have a high risk to develop lung cancer. HOXA9 expression was detected in 5 (21%) of the 24 specimens analyzed, as illustrated in FIG. 2F. The frequencies of HOXA9 expression in epithelial cells obtained from patients afflicted with NSCLC (frequency=100%) and those obtained from former smokers (frequency=24%) are statistically significant (P>0.001, as assessed using Fisher's exact test). These results indicate that activation of HOXA9 in bronchial cells is an early step necessary for the development of NSCLC.

[0085] HOXA9 expression can therefore be used as a biomarker for identification of high-risk population or for diagnosis of lung cancer at an early stage, either alone or in combination with other strategies such as spiral computer tomography (Henschke et al., 1999, Lancet 354:99-105). These results also indicate that tumorigenesis and tumor progression associated with NSCLC require HOXA9 gene expression. Thus, compounds which inhibit expression of the HOXA9 gene can be used to inhibit or reverse tumorigenesis and tumor progression in lung cells. By assaying cells which normally express (or which have been caused to express) the HOXA9 gene in the presence and absence of a test compound, one can determine whether the test compound is useful for preventing, inhibiting, treating, or even curing NSCLC.

[0086] The disclosure of every patent, patent application, and publication cited herein is hereby incorporated herein by reference in its entirety.

[0087] While this invention has been disclosed with reference to specific embodiments, it is apparent that other embodiments and variations of this invention can be devised by others skilled in the art without departing from the true spirit and scope of the invention. The appended claims include all such embodiments and equivalent variations.

1 7 1 20 DNA Artificial HoxA9 PCR Primer 1 ccggccttat ggcattaaac 20 2 20 DNA Artificial HoxA9 PCR Primer 2 agttggctgc tgggttattg 20 3 218 DNA Artificial HoxA9 Probe 3 ccggccttat ggcattaaac ctgaaccgct gtcggccaga aggggtgact gtcccacgct 60 tgacactcac actttgtccc tgactgacta tgcttgtggt tctcctccag ttgatagaga 120 aaaacaaccc agcgaaggcg ccttctccga aaacaatgcc gagaatgaga gcggcggaga 180 caagcccccc atcgatccca ataacccagc agccaact 218 4 5910 DNA Homo sapiens CDS (337)..(4632) 4 cggaggacag ccggaccgag ccaacgccgg ggactttgtt ccctccacgg aggggactcg 60 gcaactcgca gcggcagggt ctggggccgg cgcctgggag ggatctgcgc cccccactca 120 ctccctagct gtgttcccgc cgccgccccg gctagtctcc ggcgctggcg cctatggtcg 180 gcctccgaca gcgctccgga gggaccgggg gagctcccag gcgcccggga ctggagactg 240 atgcatgagg ggcctacgga ggcgcaggag cggtggtgat ggtctgggaa gcggagctga 300 agtcccctgg gctttggtga ggcgtgacag tttatc atg acc gtg ttc agg cag 354 Met Thr Val Phe Arg Gln 1 5 gaa aac gtg gat gat tac tac gac acc ggc gag gaa ctt ggc agt gga 402 Glu Asn Val Asp Asp Tyr Tyr Asp Thr Gly Glu Glu Leu Gly Ser Gly 10 15 20 cag ttt gcg gtt gtg aag aaa tgc cgt gag aaa agt acc ggc ctc cag 450 Gln Phe Ala Val Val Lys Lys Cys Arg Glu Lys Ser Thr Gly Leu Gln 25 30 35 tat gcc gcc aaa ttc atc aag aaa agg agg act aag tcc agc cgg cgg 498 Tyr Ala Ala Lys Phe Ile Lys Lys Arg Arg Thr Lys Ser Ser Arg Arg 40 45 50 ggt gtg agc cgc gag gac atc gag cgg gag gtc agc atc ctg aag gag 546 Gly Val Ser Arg Glu Asp Ile Glu Arg Glu Val Ser Ile Leu Lys Glu 55 60 65 70 atc cag cac ccc aat gtc atc acc ctg cac gag gtc tat gag aac aag 594 Ile Gln His Pro Asn Val Ile Thr Leu His Glu Val Tyr Glu Asn Lys 75 80 85 acg gac gtc atc ctg atc ttg gaa ctc gtt gca ggt ggc gag ctg ttt 642 Thr Asp Val Ile Leu Ile Leu Glu Leu Val Ala Gly Gly Glu Leu Phe 90 95 100 gac ttc tta gct gaa aag gaa tct tta act gaa gag gaa gca act gaa 690 Asp Phe Leu Ala Glu Lys Glu Ser Leu Thr Glu Glu Glu Ala Thr Glu 105 110 115 ttt ctc aaa caa att ctt aat ggt gtt tac tac ctg cac tcc ctt caa 738 Phe Leu Lys Gln Ile Leu Asn Gly Val Tyr Tyr Leu His Ser Leu Gln 120 125 130 atc gcc cac ttt gat ctt aag cct gag aac ata atg ctt ttg gat aga 786 Ile Ala His Phe Asp Leu Lys Pro Glu Asn Ile Met Leu Leu Asp Arg 135 140 145 150 aat gtc ccc aaa cct cgg atc aag atc att gac ttt ggg ttg gcc cat 834 Asn Val Pro Lys Pro Arg Ile Lys Ile Ile Asp Phe Gly Leu Ala His 155 160 165 aaa att gac ttt gga aat gaa ttt aaa aac ata ttt ggg act cca gag 882 Lys Ile Asp Phe Gly Asn Glu Phe Lys Asn Ile Phe Gly Thr Pro Glu 170 175 180 ttt gtc gct cct gag ata gtc aac tat gaa cct ctt ggt ctt gag gca 930 Phe Val Ala Pro Glu Ile Val Asn Tyr Glu Pro Leu Gly Leu Glu Ala 185 190 195 gat atg tgg agt atc ggg gta ata acc tat atc ctc cta agt ggg gcc 978 Asp Met Trp Ser Ile Gly Val Ile Thr Tyr Ile Leu Leu Ser Gly Ala 200 205 210 tcc cca ttt ctt gga gac act aag caa gaa acg tta gca aat gta tcc 1026 Ser Pro Phe Leu Gly Asp Thr Lys Gln Glu Thr Leu Ala Asn Val Ser 215 220 225 230 gct gtc aac tac gaa ttt gag gat gaa tac ttc agt aat acc agt gcc 1074 Ala Val Asn Tyr Glu Phe Glu Asp Glu Tyr Phe Ser Asn Thr Ser Ala 235 240 245 cta gcc aaa gat ttc ata aga aga ctt ctg gtc aag gat cca aag aag 1122 Leu Ala Lys Asp Phe Ile Arg Arg Leu Leu Val Lys Asp Pro Lys Lys 250 255 260 aga atg aca att caa gat agt ttg cag cat ccc tgg atc aag cct aaa 1170 Arg Met Thr Ile Gln Asp Ser Leu Gln His Pro Trp Ile Lys Pro Lys 265 270 275 gat aca caa cag gca ctt agt aga aaa gca tca gca gta aac atg gag 1218 Asp Thr Gln Gln Ala Leu Ser Arg Lys Ala Ser Ala Val Asn Met Glu 280 285 290 aaa ttc aag aag ttt gca gcc cgg aaa aaa tgg aaa caa tcc gtt cgc 1266 Lys Phe Lys Lys Phe Ala Ala Arg Lys Lys Trp Lys Gln Ser Val Arg 295 300 305 310 ttg ata tca ctg tgc caa aga tta tcc agg tca ttc ctg tcc aga agt 1314 Leu Ile Ser Leu Cys Gln Arg Leu Ser Arg Ser Phe Leu Ser Arg Ser 315 320 325 aac atg agt gtt gcc aga agc gat gat act ctg gat gag gaa gac tcc 1362 Asn Met Ser Val Ala Arg Ser Asp Asp Thr Leu Asp Glu Glu Asp Ser 330 335 340 ttt gtg atg aaa gcc atc atc cat gcc atc aac gat gac aat gtc cca 1410 Phe Val Met Lys Ala Ile Ile His Ala Ile Asn Asp Asp Asn Val Pro 345 350 355 ggc ctg cag cac ctt ctg ggc tca tta tcc aac tat gat gtt aac caa 1458 Gly Leu Gln His Leu Leu Gly Ser Leu Ser Asn Tyr Asp Val Asn Gln 360 365 370 ccc aac aag cac ggg aca cct cca tta ctc att gct gct ggc tgt ggg 1506 Pro Asn Lys His Gly Thr Pro Pro Leu Leu Ile Ala Ala Gly Cys Gly 375 380 385 390 aat att caa ata cta cag ttg ctc att aaa aga ggc tcg aga atc gat 1554 Asn Ile Gln Ile Leu Gln Leu Leu Ile Lys Arg Gly Ser Arg Ile Asp 395 400 405 gtc cag gat aag ggc ggg tcc aat gcc gtc tac tgg gct gct cgg cat 1602 Val Gln Asp Lys Gly Gly Ser Asn Ala Val Tyr Trp Ala Ala Arg His 410 415 420 ggc cac gtc gat acc ttg aaa ttt ctc agt gag aac aaa tgc cct ttg 1650 Gly His Val Asp Thr Leu Lys Phe Leu Ser Glu Asn Lys Cys Pro Leu 425 430 435 gat gtg aaa gac aag tct gga gag atg gcc ctc cac gtg gca gct cgc 1698 Asp Val Lys Asp Lys Ser Gly Glu Met Ala Leu His Val Ala Ala Arg 440 445 450 tat ggc cat gct gac gtg gct caa gtt act tgt gca gct tcg gct caa 1746 Tyr Gly His Ala Asp Val Ala Gln Val Thr Cys Ala Ala Ser Ala Gln 455 460 465 470 atc cca ata tcc agg aca aag gaa gaa gaa acc ccc ctg cac tgt gct 1794 Ile Pro Ile Ser Arg Thr Lys Glu Glu Glu Thr Pro Leu His Cys Ala 475 480 485 gct tgg cac ggc tat tac tct gtg gcc aaa gcc ctt tgt gaa gcc ggc 1842 Ala Trp His Gly Tyr Tyr Ser Val Ala Lys Ala Leu Cys Glu Ala Gly 490 495 500 tgt aac gtg aac atc aag aac cga gaa gga gag acg ccc ctc ctg aca 1890 Cys Asn Val Asn Ile Lys Asn Arg Glu Gly Glu Thr Pro Leu Leu Thr 505 510 515 gcc tct gcc agg ggc tac cac gac atc gtg gag tgt ctg gcc gaa cat 1938 Ala Ser Ala Arg Gly Tyr His Asp Ile Val Glu Cys Leu Ala Glu His 520 525 530 gga gcc gac ctt aat gct tgc gac aag gac gga cac att gcc ctt cat 1986 Gly Ala Asp Leu Asn Ala Cys Asp Lys Asp Gly His Ile Ala Leu His 535 540 545 550 ctg gct gta aga cgg tgt cag atg gag gta atc aag act ctc ctc agc 2034 Leu Ala Val Arg Arg Cys Gln Met Glu Val Ile Lys Thr Leu Leu Ser 555 560 565 caa ggg tgt ttc gtc gat tat caa gac agg cac ggc aat act ccc ctc 2082 Gln Gly Cys Phe Val Asp Tyr Gln Asp Arg His Gly Asn Thr Pro Leu 570 575 580 cat gtg gca tgt aaa gat ggc aac atg cct atc gtg gtg gcc ctc tgt 2130 His Val Ala Cys Lys Asp Gly Asn Met Pro Ile Val Val Ala Leu Cys 585 590 595 gaa gca aac tgc aat ttg gac atc tcc aac aag tat ggg cga acg cct 2178 Glu Ala Asn Cys Asn Leu Asp Ile Ser Asn Lys Tyr Gly Arg Thr Pro 600 605 610 ctg cac ctt gcg gcc aac aac gga atc cta gac gtg gtc cgg tat ctc 2226 Leu His Leu Ala Ala Asn Asn Gly Ile Leu Asp Val Val Arg Tyr Leu 615 620 625 630 tgt ctg atg gga gcc agc gtt gag gcg ctg acc acg gac gga aag acg 2274 Cys Leu Met Gly Ala Ser Val Glu Ala Leu Thr Thr Asp Gly Lys Thr 635 640 645 gca gaa gat ctt gct aga tcg gaa cag cac gag cac gta gca ggt ctc 2322 Ala Glu Asp Leu Ala Arg Ser Glu Gln His Glu His Val Ala Gly Leu 650 655 660 ctt gca aga ctt cga aag gat acg cac cga gga ctc ttc atc cag cag 2370 Leu Ala Arg Leu Arg Lys Asp Thr His Arg Gly Leu Phe Ile Gln Gln 665 670 675 ctc cga ccc aca cag aac ctg cag cca aga att aag ctc aag ctg ttt 2418 Leu Arg Pro Thr Gln Asn Leu Gln Pro Arg Ile Lys Leu Lys Leu Phe 680 685 690 ggc cac tcg gga tcc ggg aaa acc acc ctt gta gaa tct ctc aag tgt 2466 Gly His Ser Gly Ser Gly Lys Thr Thr Leu Val Glu Ser Leu Lys Cys 695 700 705 710 ggg ctg ctg agg agc ttt ttc aga agg cgt cgg ccc aga ctg tct tcc 2514 Gly Leu Leu Arg Ser Phe Phe Arg Arg Arg Arg Pro Arg Leu Ser Ser 715 720 725 acc aac tcc agc agg ttc cca cct tca ccc ctg gct tct aag ccc aca 2562 Thr Asn Ser Ser Arg Phe Pro Pro Ser Pro Leu Ala Ser Lys Pro Thr 730 735 740 gtc tca gtg agc atc aac aac ctg tac cca ggc tgc gag aac gtg agt 2610 Val Ser Val Ser Ile Asn Asn Leu Tyr Pro Gly Cys Glu Asn Val Ser 745 750 755 gtg agg agc cgc agc atg atg ttc gag ccg ggt ctt acc aaa ggg atg 2658 Val Arg Ser Arg Ser Met Met Phe Glu Pro Gly Leu Thr Lys Gly Met 760 765 770 ctg gag gtg ttt gtg gcc ccg acc cac cac ccg cac tgc tcg gcc gat 2706 Leu Glu Val Phe Val Ala Pro Thr His His Pro His Cys Ser Ala Asp 775 780 785 790 gac cag tcc acc aag gcc atc gac atc cag aac gct tat ttg aat gga 2754 Asp Gln Ser Thr Lys Ala Ile Asp Ile Gln Asn Ala Tyr Leu Asn Gly 795 800 805 gtt ggc gat ttc agc gtg tgg gag ttc tct gga aat cct gtg tat ttc 2802 Val Gly Asp Phe Ser Val Trp Glu Phe Ser Gly Asn Pro Val Tyr Phe 810 815 820 tgc tgt tat gac tat ttt gct gca aat gat ccc acg tca atc cat gtt 2850 Cys Cys Tyr Asp Tyr Phe Ala Ala Asn Asp Pro Thr Ser Ile His Val 825 830 835 gtt gtc ttt agt cta gaa gag ccc tat gag atc cag ctg aac cca gtg 2898 Val Val Phe Ser Leu Glu Glu Pro Tyr Glu Ile Gln Leu Asn Pro Val 840 845 850 att ttc tgg ctc agt ttc ctg aag tcc ctt gtc cca gtt gaa gaa ccc 2946 Ile Phe Trp Leu Ser Phe Leu Lys Ser Leu Val Pro Val Glu Glu Pro 855 860 865 870 ata gcc ttc ggt ggc aag ctg aag aac cca ctc caa gtt gtc ctg gtg 2994 Ile Ala Phe Gly Gly Lys Leu Lys Asn Pro Leu Gln Val Val Leu Val 875 880 885 gcc acc cac gct gac atc atg aat gtt cct cga ccg gct gga ggc gag 3042 Ala Thr His Ala Asp Ile Met Asn Val Pro Arg Pro Ala Gly Gly Glu 890 895 900 ttt gga tat gac aaa gac aca tcg ttg ctg aaa gag att agg aac agg 3090 Phe Gly Tyr Asp Lys Asp Thr Ser Leu Leu Lys Glu Ile Arg Asn Arg 905 910 915 ttt gga aat gat ctt cac att tca aat aag ctg ttt gtt ctg gat gct 3138 Phe Gly Asn Asp Leu His Ile Ser Asn Lys Leu Phe Val Leu Asp Ala 920 925 930 ggg gct tct ggg tca aag gac atg aag gta ctt cga aat cat ctg caa 3186 Gly Ala Ser Gly Ser Lys Asp Met Lys Val Leu Arg Asn His Leu Gln 935 940 945 950 gaa ata cga agc cag att gtt tcg gtc tgt cct ccc atg act cac ctg 3234 Glu Ile Arg Ser Gln Ile Val Ser Val Cys Pro Pro Met Thr His Leu 955 960 965 tgt gag aaa atc atc tcc acg ctg cct tcc tgg agg aag ctc aat gga 3282 Cys Glu Lys Ile Ile Ser Thr Leu Pro Ser Trp Arg Lys Leu Asn Gly 970 975 980 ccc aac cag ctg atg tcg ctg cag cag ttt gtg tac gac gtg cag gac 3330 Pro Asn Gln Leu Met Ser Leu Gln Gln Phe Val Tyr Asp Val Gln Asp 985 990 995 cag ctg aac ccc ctg gcc agc gag gag gac ctc agg cgc att gct 3375 Gln Leu Asn Pro Leu Ala Ser Glu Glu Asp Leu Arg Arg Ile Ala 1000 1005 1010 cag cag ctc cac agc aca ggc gag atc aac atc atg caa agt gaa 3420 Gln Gln Leu His Ser Thr Gly Glu Ile Asn Ile Met Gln Ser Glu 1015 1020 1025 aca gtt cag gac gtg ctg ctc ctg gac ccc cgc tgg ctc tgc aca 3465 Thr Val Gln Asp Val Leu Leu Leu Asp Pro Arg Trp Leu Cys Thr 1030 1035 1040 aac gtc ctg ggg aag ttg ctg tcc gtg gag acc cca cgg gcg ctg 3510 Asn Val Leu Gly Lys Leu Leu Ser Val Glu Thr Pro Arg Ala Leu 1045 1050 1055 cac cac tac cgg ggc cgc tac acc gtg gag gac atc cag cgc ctg 3555 His His Tyr Arg Gly Arg Tyr Thr Val Glu Asp Ile Gln Arg Leu 1060 1065 1070 gtg ccc gac agc gac gtg gag gag ctg ctg cag atc ctc gat gcc 3600 Val Pro Asp Ser Asp Val Glu Glu Leu Leu Gln Ile Leu Asp Ala 1075 1080 1085 atg gac atc tgc gcc cgg gac ctg agc agc ggg acc atg gtg gac 3645 Met Asp Ile Cys Ala Arg Asp Leu Ser Ser Gly Thr Met Val Asp 1090 1095 1100 gtc cca gcc ctg atc aag aca gac aac ctg cac cgc tcc tgg gct 3690 Val Pro Ala Leu Ile Lys Thr Asp Asn Leu His Arg Ser Trp Ala 1105 1110 1115 gat gag gag gac gag gtg atg gtg tat ggt ggc gtg cgc atc gtg 3735 Asp Glu Glu Asp Glu Val Met Val Tyr Gly Gly Val Arg Ile Val 1120 1125 1130 ccc gtg gaa cac ctc acc ccc ttc cca tgt ggc atc ttt cac aag 3780 Pro Val Glu His Leu Thr Pro Phe Pro Cys Gly Ile Phe His Lys 1135 1140 1145 gtc cag gtg aac ctg tgc cgg tgg atc cac cag caa agc aca gag 3825 Val Gln Val Asn Leu Cys Arg Trp Ile His Gln Gln Ser Thr Glu 1150 1155 1160 ggc gac gcg gac atc cgc ctg tgg gtg aat ggc tgc aag ctg gcc 3870 Gly Asp Ala Asp Ile Arg Leu Trp Val Asn Gly Cys Lys Leu Ala 1165 1170 1175 aac cgt ggg gcc gag ctg ctg gtg ctg ctg gtc aac cac ggc cag 3915 Asn Arg Gly Ala Glu Leu Leu Val Leu Leu Val Asn His Gly Gln 1180 1185 1190 ggc att gag gtc cag gtc cgt ggc ctg gag acg gag aag atc aag 3960 Gly Ile Glu Val Gln Val Arg Gly Leu Glu Thr Glu Lys Ile Lys 1195 1200 1205 tgc tgc ctg ctg ctg gac tcg gtg tgc agc acc att gag aac gtc 4005 Cys Cys Leu Leu Leu Asp Ser Val Cys Ser Thr Ile Glu Asn Val 1210 1215 1220 atg gcc acc acg ctg cca ggg ctc ctg acc gtg aag cat tac ctg 4050 Met Ala Thr Thr Leu Pro Gly Leu Leu Thr Val Lys His Tyr Leu 1225 1230 1235 agc ccc cag cag ctg cgg gag cac cat gag ccc gtc atg atc tac 4095 Ser Pro Gln Gln Leu Arg Glu His His Glu Pro Val Met Ile Tyr 1240 1245 1250 cag cca cgg gac ttc ttc cgg gca cag act ctg aag gaa acc tca 4140 Gln Pro Arg Asp Phe Phe Arg Ala Gln Thr Leu Lys Glu Thr Ser 1255 1260 1265 ctg acc aac acc atg ggg ggg tac aag gaa agc ttc agc agc atc 4185 Leu Thr Asn Thr Met Gly Gly Tyr Lys Glu Ser Phe Ser Ser Ile 1270 1275 1280 atg tgc ttc ggg tgt cac gac gtc tac tca cag gcc agc ctc ggc 4230 Met Cys Phe Gly Cys His Asp Val Tyr Ser Gln Ala Ser Leu Gly 1285 1290 1295 atg gac atc cat gca tca gac ctg aac ctc ctc act cgg agg aaa 4275 Met Asp Ile His Ala Ser Asp Leu Asn Leu Leu Thr Arg Arg Lys 1300 1305 1310 ctg agt cgc ctg ctg gac ccg ccc gac ccc ctg ggg aag gac tgg 4320 Leu Ser Arg Leu Leu Asp Pro Pro Asp Pro Leu Gly Lys Asp Trp 1315 1320 1325 tgc ctt ctc gcc atg aac tta ggc ctc cct gac ctc gtg gca aag 4365 Cys Leu Leu Ala Met Asn Leu Gly Leu Pro Asp Leu Val Ala Lys 1330 1335 1340 tac aac acc aat aac ggg gct ccc aag gat ttc ctc ccc agc ccc 4410 Tyr Asn Thr Asn Asn Gly Ala Pro Lys Asp Phe Leu Pro Ser Pro 1345 1350 1355 ctc cac gcc ctg ctg cgg gaa tgg acc acc tac cct gag agc aca 4455 Leu His Ala Leu Leu Arg Glu Trp Thr Thr Tyr Pro Glu Ser Thr 1360 1365 1370 gtg ggc acc ctc atg tcc aaa ctg agg gag ctg ggt cgc cgg gat 4500 Val Gly Thr Leu Met Ser Lys Leu Arg Glu Leu Gly Arg Arg Asp 1375 1380 1385 gcc gca gac ctt ttg ctg aag gca tcc tct gtg ttc aaa atc aac 4545 Ala Ala Asp Leu Leu Leu Lys Ala Ser Ser Val Phe Lys Ile Asn 1390 1395 1400 ctg gat ggc aat ggc cag gag gcc tat gcc tcg agc tgc aac agc 4590 Leu Asp Gly Asn Gly Gln Glu Ala Tyr Ala Ser Ser Cys Asn Ser 1405 1410 1415 ggc acc tct tac aat tcc att agc tct gtt gta tcc cgg tga 4632 Gly Thr Ser Tyr Asn Ser Ile Ser Ser Val Val Ser Arg 1420 1425 1430 gggcagcctc tggcttggac agggtctgtt tggactgcag aaccaagggg gtgatgtagc 4692 ccatccttcc ctttggagat gctgagggtg tttcttcctg cacccacagc cagggggatg 4752 ccactcctcc ctccggcttg acctgtttct ctgccgctac ctccctcccc gtctcattcc 4812 gttgtctgtg gatggtcatt gcagtttaag agcagaacag atcttttact ttggccgctt 4872 gaaaagctag tgtacctcct ctcagtgttt tggactccat ctctcatcct ccagtacctt 4932 gcttcttact gataattttg ctggaattcc taacttttca atgacatttt ttttaactat 4992 catattgatt gtcctttaaa aaagaaaagt gcatatttat ccaaaatgtg tatttcttat 5052 acgcttttct gtgttatacc atttcctcag cttatctctt ttatatttgt aggagaaact 5112 cccatgtatg gaatcccact gtatgattta taaacagaca atatgtgagt gccttttgca 5172 gaagagggtg tgtttgaaat catcggagtc agccaggagc tgtcaccaag gaaacgctac 5232 ctctctgtcc cttgctgtat gctgatcatc gccagaggtg cttcaccctg agttttgttt 5292 tgtattgttt tctgacagtt tttctgtttt gtttggcaag gaaaggggag aagggaatcc 5352 tcctccaggg tgattttatg atcagtgttg ttgctctagg aagacatttt tccgtttgct 5412 tttgttccaa tgtcaatgtg aacgtccaca tgaaacctac acactgtcat gcttcatcat 5472 tccctctcat ctcaggtaga aggttgacac agttgtaggg ttacagagac ctatgtaaga 5532 attcagaaga cccctgactc atcatttgtg gcagtccctt ataattggtg catagcagat 5592 ggtttccaca tttagatcct ggtttcataa cttcctgtac ttgaagtcta aaagcagaaa 5652 ataaaggaag caagttttct tccatgattt taaattgtga tcgagtttta aattgatagg 5712 agggaacatg tcctaattct tctgtcctga gaagcatgta atgttaatgt tatatcatat 5772 gtatatatat atatgcacta tgtatataca tatatattaa tactggtatt tttacttaat 5832 ctataaaatg tcgttaaaaa gttgtttgtt tttttctttt tttataaata aactgttgct 5892 cgttaaaaaa aaaaaaaa 5910 5 1431 PRT Homo sapiens 5 Met Thr Val Phe Arg Gln Glu Asn Val Asp Asp Tyr Tyr Asp Thr Gly 1 5 10 15 Glu Glu Leu Gly Ser Gly Gln Phe Ala Val Val Lys Lys Cys Arg Glu 20 25 30 Lys Ser Thr Gly Leu Gln Tyr Ala Ala Lys Phe Ile Lys Lys Arg Arg 35 40 45 Thr Lys Ser Ser Arg Arg Gly Val Ser Arg Glu Asp Ile Glu Arg Glu 50 55 60 Val Ser Ile Leu Lys Glu Ile Gln His Pro Asn Val Ile Thr Leu His 65 70 75 80 Glu Val Tyr Glu Asn Lys Thr Asp Val Ile Leu Ile Leu Glu Leu Val 85 90 95 Ala Gly Gly Glu Leu Phe Asp Phe Leu Ala Glu Lys Glu Ser Leu Thr 100 105 110 Glu Glu Glu Ala Thr Glu Phe Leu Lys Gln Ile Leu Asn Gly Val Tyr 115 120 125 Tyr Leu His Ser Leu Gln Ile Ala His Phe Asp Leu Lys Pro Glu Asn 130 135 140 Ile Met Leu Leu Asp Arg Asn Val Pro Lys Pro Arg Ile Lys Ile Ile 145 150 155 160 Asp Phe Gly Leu Ala His Lys Ile Asp Phe Gly Asn Glu Phe Lys Asn 165 170 175 Ile Phe Gly Thr Pro Glu Phe Val Ala Pro Glu Ile Val Asn Tyr Glu 180 185 190 Pro Leu Gly Leu Glu Ala Asp Met Trp Ser Ile Gly Val Ile Thr Tyr 195 200 205 Ile Leu Leu Ser Gly Ala Ser Pro Phe Leu Gly Asp Thr Lys Gln Glu 210 215 220 Thr Leu Ala Asn Val Ser Ala Val Asn Tyr Glu Phe Glu Asp Glu Tyr 225 230 235 240 Phe Ser Asn Thr Ser Ala Leu Ala Lys Asp Phe Ile Arg Arg Leu Leu 245 250 255 Val Lys Asp Pro Lys Lys Arg Met Thr Ile Gln Asp Ser Leu Gln His 260 265 270 Pro Trp Ile Lys Pro Lys Asp Thr Gln Gln Ala Leu Ser Arg Lys Ala 275 280 285 Ser Ala Val Asn Met Glu Lys Phe Lys Lys Phe Ala Ala Arg Lys Lys 290 295 300 Trp Lys Gln Ser Val Arg Leu Ile Ser Leu Cys Gln Arg Leu Ser Arg 305 310 315 320 Ser Phe Leu Ser Arg Ser Asn Met Ser Val Ala Arg Ser Asp Asp Thr 325 330 335 Leu Asp Glu Glu Asp Ser Phe Val Met Lys Ala Ile Ile His Ala Ile 340 345 350 Asn Asp Asp Asn Val Pro Gly Leu Gln His Leu Leu Gly Ser Leu Ser 355 360 365 Asn Tyr Asp Val Asn Gln Pro Asn Lys His Gly Thr Pro Pro Leu Leu 370 375 380 Ile Ala Ala Gly Cys Gly Asn Ile Gln Ile Leu Gln Leu Leu Ile Lys 385 390 395 400 Arg Gly Ser Arg Ile Asp Val Gln Asp Lys Gly Gly Ser Asn Ala Val 405 410 415 Tyr Trp Ala Ala Arg His Gly His Val Asp Thr Leu Lys Phe Leu Ser 420 425 430 Glu Asn Lys Cys Pro Leu Asp Val Lys Asp Lys Ser Gly Glu Met Ala 435 440 445 Leu His Val Ala Ala Arg Tyr Gly His Ala Asp Val Ala Gln Val Thr 450 455 460 Cys Ala Ala Ser Ala Gln Ile Pro Ile Ser Arg Thr Lys Glu Glu Glu 465 470 475 480 Thr Pro Leu His Cys Ala Ala Trp His Gly Tyr Tyr Ser Val Ala Lys 485 490 495 Ala Leu Cys Glu Ala Gly Cys Asn Val Asn Ile Lys Asn Arg Glu Gly 500 505 510 Glu Thr Pro Leu Leu Thr Ala Ser Ala Arg Gly Tyr His Asp Ile Val 515 520 525 Glu Cys Leu Ala Glu His Gly Ala Asp Leu Asn Ala Cys Asp Lys Asp 530 535 540 Gly His Ile Ala Leu His Leu Ala Val Arg Arg Cys Gln Met Glu Val 545 550 555 560 Ile Lys Thr Leu Leu Ser Gln Gly Cys Phe Val Asp Tyr Gln Asp Arg 565 570 575 His Gly Asn Thr Pro Leu His Val Ala Cys Lys Asp Gly Asn Met Pro 580 585 590 Ile Val Val Ala Leu Cys Glu Ala Asn Cys Asn Leu Asp Ile Ser Asn 595 600 605 Lys Tyr Gly Arg Thr Pro Leu His Leu Ala Ala Asn Asn Gly Ile Leu 610 615 620 Asp Val Val Arg Tyr Leu Cys Leu Met Gly Ala Ser Val Glu Ala Leu 625 630 635 640 Thr Thr Asp Gly Lys Thr Ala Glu Asp Leu Ala Arg Ser Glu Gln His 645 650 655 Glu His Val Ala Gly Leu Leu Ala Arg Leu Arg Lys Asp Thr His Arg 660 665 670 Gly Leu Phe Ile Gln Gln Leu Arg Pro Thr Gln Asn Leu Gln Pro Arg 675 680 685 Ile Lys Leu Lys Leu Phe Gly His Ser Gly Ser Gly Lys Thr Thr Leu 690 695 700 Val Glu Ser Leu Lys Cys Gly Leu Leu Arg Ser Phe Phe Arg Arg Arg 705 710 715 720 Arg Pro Arg Leu Ser Ser Thr Asn Ser Ser Arg Phe Pro Pro Ser Pro 725 730 735 Leu Ala Ser Lys Pro Thr Val Ser Val Ser Ile Asn Asn Leu Tyr Pro 740 745 750 Gly Cys Glu Asn Val Ser Val Arg Ser Arg Ser Met Met Phe Glu Pro 755 760 765 Gly Leu Thr Lys Gly Met Leu Glu Val Phe Val Ala Pro Thr His His 770 775 780 Pro His Cys Ser Ala Asp Asp Gln Ser Thr Lys Ala Ile Asp Ile Gln 785 790 795 800 Asn Ala Tyr Leu Asn Gly Val Gly Asp Phe Ser Val Trp Glu Phe Ser 805 810 815 Gly Asn Pro Val Tyr Phe Cys Cys Tyr Asp Tyr Phe Ala Ala Asn Asp 820 825 830 Pro Thr Ser Ile His Val Val Val Phe Ser Leu Glu Glu Pro Tyr Glu 835 840 845 Ile Gln Leu Asn Pro Val Ile Phe Trp Leu Ser Phe Leu Lys Ser Leu 850 855 860 Val Pro Val Glu Glu Pro Ile Ala Phe Gly Gly Lys Leu Lys Asn Pro 865 870 875 880 Leu Gln Val Val Leu Val Ala Thr His Ala Asp Ile Met Asn Val Pro 885 890 895 Arg Pro Ala Gly Gly Glu Phe Gly Tyr Asp Lys Asp Thr Ser Leu Leu 900 905 910 Lys Glu Ile Arg Asn Arg Phe Gly Asn Asp Leu His Ile Ser Asn Lys 915 920 925 Leu Phe Val Leu Asp Ala Gly Ala Ser Gly Ser Lys Asp Met Lys Val 930 935 940 Leu Arg Asn His Leu Gln Glu Ile Arg Ser Gln Ile Val Ser Val Cys 945 950 955 960 Pro Pro Met Thr His Leu Cys Glu Lys Ile Ile Ser Thr Leu Pro Ser 965 970 975 Trp Arg Lys Leu Asn Gly Pro Asn Gln Leu Met Ser Leu Gln Gln Phe 980 985 990 Val Tyr Asp Val Gln Asp Gln Leu Asn Pro Leu Ala Ser Glu Glu Asp 995 1000 1005 Leu Arg Arg Ile Ala Gln Gln Leu His Ser Thr Gly Glu Ile Asn 1010 1015 1020 Ile Met Gln Ser Glu Thr Val Gln Asp Val Leu Leu Leu Asp Pro 1025 1030 1035 Arg Trp Leu Cys Thr Asn Val Leu Gly Lys Leu Leu Ser Val Glu 1040 1045 1050 Thr Pro Arg Ala Leu His His Tyr Arg Gly Arg Tyr Thr Val Glu 1055 1060 1065 Asp Ile Gln Arg Leu Val Pro Asp Ser Asp Val Glu Glu Leu Leu 1070 1075 1080 Gln Ile Leu Asp Ala Met Asp Ile Cys Ala Arg Asp Leu Ser Ser 1085 1090 1095 Gly Thr Met Val Asp Val Pro Ala Leu Ile Lys Thr Asp Asn Leu 1100 1105 1110 His Arg Ser Trp Ala Asp Glu Glu Asp Glu Val Met Val Tyr Gly 1115 1120 1125 Gly Val Arg Ile Val Pro Val Glu His Leu Thr Pro Phe Pro Cys 1130 1135 1140 Gly Ile Phe His Lys Val Gln Val Asn Leu Cys Arg Trp Ile His 1145 1150 1155 Gln Gln Ser Thr Glu Gly Asp Ala Asp Ile Arg Leu Trp Val Asn 1160 1165 1170 Gly Cys Lys Leu Ala Asn Arg Gly Ala Glu Leu Leu Val Leu Leu 1175 1180 1185 Val Asn His Gly Gln Gly Ile Glu Val Gln Val Arg Gly Leu Glu 1190 1195 1200 Thr Glu Lys Ile Lys Cys Cys Leu Leu Leu Asp Ser Val Cys Ser 1205 1210 1215 Thr Ile Glu Asn Val Met Ala Thr Thr Leu Pro Gly Leu Leu Thr 1220 1225 1230 Val Lys His Tyr Leu Ser Pro Gln Gln Leu Arg Glu His His Glu 1235 1240 1245 Pro Val Met Ile Tyr Gln Pro Arg Asp Phe Phe Arg Ala Gln Thr 1250 1255 1260 Leu Lys Glu Thr Ser Leu Thr Asn Thr Met Gly Gly Tyr Lys Glu 1265 1270 1275 Ser Phe Ser Ser Ile Met Cys Phe Gly Cys His Asp Val Tyr Ser 1280 1285 1290 Gln Ala Ser Leu Gly Met Asp Ile His Ala Ser Asp Leu Asn Leu 1295 1300 1305 Leu Thr Arg Arg Lys Leu Ser Arg Leu Leu Asp Pro Pro Asp Pro 1310 1315 1320 Leu Gly Lys Asp Trp Cys Leu Leu Ala Met Asn Leu Gly Leu Pro 1325 1330 1335 Asp Leu Val Ala Lys Tyr Asn Thr Asn Asn Gly Ala Pro Lys Asp 1340 1345 1350 Phe Leu Pro Ser Pro Leu His Ala Leu Leu Arg Glu Trp Thr Thr 1355 1360 1365 Tyr Pro Glu Ser Thr Val Gly Thr Leu Met Ser Lys Leu Arg Glu 1370 1375 1380 Leu Gly Arg Arg Asp Ala Ala Asp Leu Leu Leu Lys Ala Ser Ser 1385 1390 1395 Val Phe Lys Ile Asn Leu Asp Gly Asn Gly Gln Glu Ala Tyr Ala 1400 1405 1410 Ser Ser Cys Asn Ser Gly Thr Ser Tyr Asn Ser Ile Ser Ser Val 1415 1420 1425 Val Ser Arg 1430 6 597 DNA Homo sapiens CDS (1)..(597) 6 atg gca ggg ttc tct cct tgg cgg cgg cgg cag cgg cgg agg cgg cgg 48 Met Ala Gly Phe Ser Pro Trp Arg Arg Arg Gln Arg Arg Arg Arg Arg 1 5 10 15 cgg cgg cgg gcg agg cac gct tcg cgg gca gca cca gaa ctg gtc ggt 96 Arg Arg Arg Ala Arg His Ala Ser Arg Ala Ala Pro Glu Leu Val Gly 20 25 30 gat tta ggt agt ttc ctg ttg ttg gga tcc acc ttt ctc tcg aca ggc 144 Asp Leu Gly Ser Phe Leu Leu Leu Gly Ser Thr Phe Leu Ser Thr Gly 35 40 45 acg aca ctg ccc ttc att act tca gtt gaa atc gtc tcc agg tac ctc 192 Thr Thr Leu Pro Phe Ile Thr Ser Val Glu Ile Val Ser Arg Tyr Leu 50 55 60 tgc gcg cgg ggg tcg ggc cgc gcg ggg cat cac ggc cct ggt cgt gcc 240 Cys Ala Arg Gly Ser Gly Arg Ala Gly His His Gly Pro Gly Arg Ala 65 70 75 80 agg cct gcg gtg gca acc tcg gct ttc cct gct cag gag cct cgt gtc 288 Arg Pro Ala Val Ala Thr Ser Ala Phe Pro Ala Gln Glu Pro Arg Val 85 90 95 ttt ctc cgc agc gct ttg cca gcc ggc cgg ctt tcc cct tcc acc aca 336 Phe Leu Arg Ser Ala Leu Pro Ala Gly Arg Leu Ser Pro Ser Thr Thr 100 105 110 cac ctc cac ctg gtc aca gca gat aac cca gca gcc aac tgg ctt cat 384 His Leu His Leu Val Thr Ala Asp Asn Pro Ala Ala Asn Trp Leu His 115 120 125 gcg cgc tcc act cgg aaa aag cgg tgc ccc tat aca aaa cac cag acc 432 Ala Arg Ser Thr Arg Lys Lys Arg Cys Pro Tyr Thr Lys His Gln Thr 130 135 140 ctg gaa ctg gag aaa gag ttt ctg ttc aac atg tac ctc acc agg gac 480 Leu Glu Leu Glu Lys Glu Phe Leu Phe Asn Met Tyr Leu Thr Arg Asp 145 150 155 160 cgc agg tac gag gtg gct cga ctg ctc aac ctc acc gag agg cag gtc 528 Arg Arg Tyr Glu Val Ala Arg Leu Leu Asn Leu Thr Glu Arg Gln Val 165 170 175 aag atc tgg ttc cag aac cgc agg atg aaa atg aag aaa atc aac aaa 576 Lys Ile Trp Phe Gln Asn Arg Arg Met Lys Met Lys Lys Ile Asn Lys 180 185 190 gac cga gca aaa gac gag tga 597 Asp Arg Ala Lys Asp Glu 195 7 198 PRT Homo sapiens 7 Met Ala Gly Phe Ser Pro Trp Arg Arg Arg Gln Arg Arg Arg Arg Arg 1 5 10 15 Arg Arg Arg Ala Arg His Ala Ser Arg Ala Ala Pro Glu Leu Val Gly 20 25 30 Asp Leu Gly Ser Phe Leu Leu Leu Gly Ser Thr Phe Leu Ser Thr Gly 35 40 45 Thr Thr Leu Pro Phe Ile Thr Ser Val Glu Ile Val Ser Arg Tyr Leu 50 55 60 Cys Ala Arg Gly Ser Gly Arg Ala Gly His His Gly Pro Gly Arg Ala 65 70 75 80 Arg Pro Ala Val Ala Thr Ser Ala Phe Pro Ala Gln Glu Pro Arg Val 85 90 95 Phe Leu Arg Ser Ala Leu Pro Ala Gly Arg Leu Ser Pro Ser Thr Thr 100 105 110 His Leu His Leu Val Thr Ala Asp Asn Pro Ala Ala Asn Trp Leu His 115 120 125 Ala Arg Ser Thr Arg Lys Lys Arg Cys Pro Tyr Thr Lys His Gln Thr 130 135 140 Leu Glu Leu Glu Lys Glu Phe Leu Phe Asn Met Tyr Leu Thr Arg Asp 145 150 155 160 Arg Arg Tyr Glu Val Ala Arg Leu Leu Asn Leu Thr Glu Arg Gln Val 165 170 175 Lys Ile Trp Phe Gln Asn Arg Arg Met Lys Met Lys Lys Ile Asn Lys 180 185 190 Asp Arg Ala Lys Asp Glu 195 

What is claimed is:
 1. A method of diagnosing non-small cell lung cancer (NSCLC) in a human, the method comprising assessing expression of the gene encoding DAP-kinase in lung cells of the human, whereby a lower degree of expression of the gene in the human, relative to a normal level of expression of the gene in humans not afflicted with NSCLC, is an indication that the human is afflicted with NSCLC.
 2. The method of claim 1, wherein expression of the gene is assessed in vitro in cells obtained from the human.
 3. The method of claim 2, wherein the cells are obtained from a bronchial lavage.
 4. The method of claim 2, wherein the cells are epithelial cells.
 5. The method of claim 1, wherein the human does not exhibit a macroscopic clinical symptom of NSCLC.
 6. The method of claim 5, wherein the symptom is selected from the group consisting of a cough that doesn't go away and gets worse over time, constant chest pain, coughing up blood, shortness of breath, wheezing, hoarseness, repeated problems with pneumonia, repeated problems with bronchitis, swelling of the neck and face, loss of appetite, weight loss, and fatigue.
 7. The method of claim 1, wherein expression of the gene is assessed by assessing the methylation state of the gene.
 8. The method of claim 7, wherein the methylation state of the gene is assessed by assessing the methylation state of the promoter CpG region of the gene.
 9. The method of claim 7, wherein the methylation state of the gene is assessed using an oligonucleotide that specifically hybridizes with the methylated form of the gene.
 10. The method of claim 9, wherein the oligonucleotide and a second oligonucleotide are used in a polymerase chain reaction (PCR) to amplify a portion of the gene.
 11. A method of assessing NSCLC tumorigenesis at an early stage in a human, the method comprising assessing methylation of the gene encoding DAP-kinase in lung cells of the human.
 12. A method of assessing aggressiveness of a NSCLC tumor in a human, the method comprising assessing methylation of the gene encoding DAP-kinase in lung cells of the human, whereby a higher degree of methylation of the gene is an indication that the tumor is more aggressive.
 13. The method of claim 12, wherein the tumor is a diagnostic stage I NSCLC tumor.
 14. A method of selecting among methods of treating a NSCLC tumor in a human, the method comprising assessing methylation of the gene encoding DAP-kinase in lung cells of the human and selecting a more aggressive treatment when a higher degree of methylation of the gene is detected.
 15. A method of inhibiting NSCLC tumorigenesis in a human, the method comprising inhibiting methylation of the DAP-kinase gene in lung cells of the human.
 16. A method of inhibiting progression of a NSCLC tumor in a human, the method comprising inhibiting methylation of the DAP-kinase gene in cells of the tumor.
 17. A method of reducing the aggressiveness of a NSCLC tumor in a human, the method comprising inhibiting methylation of the DAP-kinase gene in cells of the tumor.
 18. A method of inhibiting NSCLC tumorigenesis in a human, the method comprising de-methylating the DAP-kinase gene in lung cells of the human.
 19. A method of inhibiting progression of a NSCLC tumor in a human, the method comprising de-methylating the DAP-kinase gene in cells of the tumor.
 20. A method of reducing the aggressiveness of a NSCLC tumor in a human, the method comprising de-methylating the DAP-kinase gene in cells of the tumor.
 21. A method of assessing the risk that a human will develop NSCLC, the method comprising assessing expression of the gene encoding DAP-kinase in lung cells of the human, whereby a lower degree of expression of the gene in the human, relative to a normal level of expression of the gene in humans not afflicted with NSCLC, is an indication that the human is at an increased risk for developing NSCLC.
 22. A method of assessing whether a test compound is useful for inhibiting a process selected from the group consisting of i) NSCLC tumorigenesis, ii) progression of a NSCLC tumor, and iii) aggressiveness of a NSCLC tumor, the method comprising comparing methylation of the DAP-kinase gene in the presence of the test compound and methylation of the gene in the absence of the test compound, whereby a lower degree of gene methylation in the presence of the test compound is an indication that the test compound is useful for inhibiting the process.
 23. A method of preventing NSCLC in a human at risk for developing NSCLC, the method comprising inhibiting methylation of the DAP-kinase gene in lung cells of the human.
 24. A method of preventing NSCLC in a human at risk for developing NSCLC, the method comprising enhancing de-methylation of the DAP-kinase gene in lung cells of the human.
 25. A method of alleviating NSCLC in a human, the method comprising inhibiting methylation of the DAP-kinase gene in lung cells of the human.
 26. A method of alleviating NSCLC in a human, the method comprising enhancing de-methylation of the DAP-kinase gene in lung cells of the human.
 27. A method of diagnosing NSCLC in a human, the method comprising assessing expression of the HOXA9 gene in lung cells of the human, whereby a greater degree of expression of the gene in the human, relative to a normal level of expression of the gene in humans not afflicted with NSCLC, is an indication that the human is afflicted with NSCLC.
 28. The method of claim 27, wherein expression of the gene is assessed in vitro in cells obtained from the human.
 29. The method of claim 28, wherein the cells are obtained from a bronchial lavage.
 30. The method of claim 28, wherein the cells are epithelial cells.
 31. The method of claim 27, wherein the human does not exhibit a macroscopic clinical symptom of NSCLC.
 32. The method of claim 31, wherein the symptom is selected from the group consisting of a cough that doesn't go away and gets worse over time, constant chest pain, coughing up blood, shortness of breath, wheezing, hoarseness, repeated problems with pneumonia, repeated problems with bronchitis, swelling of the neck and face, loss of appetite, weight loss, and fatigue.
 33. The method of claim 27, wherein expression of the gene is assessed using an oligonucleotide that specifically hybridizes with a transcription product of the gene.
 34. The method of claim 33, wherein the oligonucleotide does not specifically hybridize with the gene.
 35. The method of claim 33, wherein the oligonucleotide and a second oligonucleotide are used in a polymerase chain reaction (PCR) to amplify a portion of the gene.
 36. The method of claim 35, wherein the portion includes sub-portions wherein an intron is interposed between the sub-portions in the gene, but wherein the sub-portions are adjacent in mRNA derived from the gene.
 37. A method of assessing the risk that a human will develop NSCLC, the method comprising assessing expression of the HOXA9 gene in lung cells of the human, whereby a greater degree of expression of the gene in the human, relative to a normal level of expression of the gene in humans not afflicted with NSCLC, is an indication that the human is at an increased risk for developing NSCLC.
 38. A method of inhibiting NSCLC tumorigenesis in a human, the method comprising inhibiting expression of the HOXA9 gene in lung cells of the human.
 39. A method of inhibiting progression of a NSCLC tumor in a human, the method comprising inhibiting expression of the HOXA9 gene in cells of the tumor.
 40. A method of assessing whether a test compound is useful for inhibiting a process selected from the group consisting of i) NSCLC tumorigenesis and ii) progression of a NSCLC tumor, the method comprising comparing expression of the HOXA9 gene in the presence of the test compound and expression of the gene in the absence of the test compound, whereby a lower degree of expression in the presence of the test compound is an indication that the test compound is useful for inhibiting the process.
 41. A method of preventing NSCLC in a human at risk for developing NSCLC, the method comprising inhibiting expression of the HOXA9 gene in lung cells of the human.
 42. A method of alleviating NSCLC in a human, the method comprising inhibiting expression of the HOXA9 gene in lung cells of the human. 